Form 4137 - Social Security and Medicare Tax On Unreported Tip Income (2014)

Form 4137
2014
Department of the Treasury
Internal Revenue Service (99)
Social Security and Medicare Tax
on Unreported Tip Income
Information about Form 4137 and its instructions is at www.irs.gov/form4137.
Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.
OMB No. 1545-0074
Attachment
Sequence No.
24
Name of person who received tips. If married, complete a separate Form 4137 for each spouse with unreported tips. Social security number
1
(a) Name of employer to whom
you were required to, but did not
report all your tips (see instructions)
(b) Employer
identification number
(see instructions)
(c) Total cash and charge
tips you received (including
unreported tips) (see instructions)
(d) Total cash and charge
tips you reported to your
employer
A
B
C
D
E
2
Total cash and charge tips you received in 2014. Add the
amounts from line 1, column (c) . . . . . . . . . . .
2
3
Total cash and charge tips you reported to your employer(s) in 2014. Add the amounts from
line 1, column (d) . . . . . . . . . . . . . . . . . . . . . . . . .
3
4
Subtract line 3 from line 2. This amount is income you must include in the total on Form
1040, line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3 . . . . . . . . . .
4
5
Cash and charge tips you received but did not report to your employer because the total was
less than $20 in a calendar month (see instructions) . . . . . . . . . . . . .
5
6 Unreported tips subject to Medicare tax. Subtract line 5 from line 4 . . . . . . . . 6
7
Maximum amount of wages (including tips) subject to
social security tax . . . . . . . . . . . . . . . .
7
8
Total social security wages and social security tips (total of
boxes 3 and 7 shown on your Form(s) W-2) and railroad
retirement (RRTA) compensation (subject to 6.2% rate) (see
instructions) . . . . . . . . . . . . . . . . . .
8
9 Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- . . . . . . . . . 9
10
Unreported tips subject to social security tax. Enter the smaller of line 6 or line 9. If you
received tips as a federal, state, or local government employee (see instructions) . . . .
10
11 Multiply line 10 by .062 (social security tax rate) . . . . . . . . . . . . . . .
11
12 Multiply line 6 by .0145 (Medicare tax rate). . . . . . . . . . . . . . . . . 12
13
Add lines 11 and 12. Enter the result here and on Form 1040, line 58; Form 1040NR, line 56;
or Form 1040NR-EZ, line 16 (Form 1040-SS and 1040-PR filers, see instructions.) . . .
13
General Instructions
Future Developments
For the latest information about developments
related to Form 4137 and its instructions,
such as legislation enacted after they were
published, go to www.irs.gov/form4137.
What's New
For 2014, the maximum wages and tips
subject to social security tax increased to
$117,000. The social security tax rate an
employee must pay on tips remains at 6.2%
(.062).
Reminder
A 0.9% Additional Medicare Tax applies to
Medicare wages, Railroad Retirement Tax Act
compensation, and self-employment income
over a threshold amount based on your filing
status. Use Form 8959, Additional Medicare
Tax, to figure this tax. For more information
on Additional Medicare Tax, go to
www.IRS.gov and enter “Additional Medicare
Tax” in the search box.
Purpose of form. Use Form 4137 only to
figure the social security and Medicare tax
owed on tips you did not report to your
employer, including any allocated tips shown
on your Form(s) W-2 that you must report as
income. You must also report the income on
Form 1040, line 7; Form 1040NR, line 8; or
Form 1040NR-EZ, line 3. By filing this form,
your social security and Medicare tips will be
credited to your social security record (used
to figure your benefits).
!
CAUTION
If you believe you are an employee
and you received Form 1099-
MISC, Miscellaneous Income,
instead of Form W-2, Wage and
Tax Statement, because your employer did
not consider you an employee, do not use this
form to report the social security and
Medicare tax on that income. Instead, use
Form 8919, Uncollected Social Security and
Medicare Tax on Wages.
For Paperwork Reduction Act Notice, see your tax return instructions.
Cat. No. 12626C
Form 4137 (2014)
Page 1/2
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Form 4137 - Social Security and Medicare Tax On Unreported Tip Income (2014) PDF

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